P1636: PATIENT PREFERENCES AND EXPERIENCES REGARDING THROMBOPOIETIN-RECEPTOR AGONISTS FOR IMMUNE THROMBOCYTOPENIA IN THE NETHERLANDS (TRAPEZE NL STUDY).
Authors: A. G. Jansen, V. McDonald, A. Newland, M. Morgan, S. Visser-Peereboom, K. Wilson, D. Eriksson, E. Geldman, O. Daykin-Pont, J. J. Zwaginga
Journal: HemaSphere (2022)

Background: Thrombopoietin-receptor agonists (TPO-RAs) are standard of care in immune thrombocytopenia (ITP) patients refractory to first-line treatment with glucocorticoids. Treatment of ITP with TPO-RAs is progressing towards integrating patient preference into management strategy. Currently, quantitative evidence evaluating the influence of therapy characteristics on patient preference has been generated in the UK via the multinational TRAPeze study (Thrombopoietin-Receptor Agonist Patient experience survey). Aims: The TRAPeze study aims to identify patient experience and preference towards specific TPO-RAs in the treatment of ITP. Methods: Presented here are results from the TRAPeze study in The Netherlands. Patients were recruited by the Dutch ITP patient association, which publicised the study via its website, social media and mailing list. The TRAPeze study used a discrete choice experiment (DCE) to elicit patient preferences regarding mode of administration, dosing frequency, drug-food interactions, platelet response, monitoring requirements and potential side effects. Additionally, a patient burden survey (PBS) determined patient demographics, disease characteristics, previous and current treatment patterns, treatment satisfaction, healthcare resource utilisation and social impact. Results: 76 respondents from The Netherlands completed the DCE. 69 respondents completed both the DCE and PBS (mean [range] age 53.3 [19-83] years, 65% female). Of those currently or most recently receiving eltrombopag (n=43) or romiplostim (n=26), 98% and 88% respectively reported satisfaction with mode of administration. 30% (n=20) previously received another TPO-RA, with loss (29%, n=6) and lack (29%, n=6) of response most commonly reported as the reason for switching. The TPO-RA characteristics which were most likely to influence patient preference were method of administration (odds ratio [OR] 4.33; 95% confidence interval [CI] 2.88–6.52), frequency of dosing (OR 2.33; 95% CI 1.86–2.92) and drug-food interactions (OR 1.91; 95% CI 1.54–2.37). Patients were more likely to prefer an oral tablet over subcutaneous injection (OR 4.22; 95% CI 2.76–6.46), a dosing frequency of once weekly over once daily (OR 2.37; 95% CI 1.58–3.54) and a therapy without food restrictions over with restrictions (OR 1.90; 95% CI 1.52–2.38). The most commonly reported ITP symptoms were fatigue (83%), bruising (81%), petechiae (71%), anxiety about platelet count (49%) and unexplained nosebleeds (29%). Fatigue was the most negatively impactful symptom for 55% of patients. 47% of employed patients reported reducing their weekly working hours, of which 60% cited fatigue as the primary reason. Although 78% of patients reported their TPO-RA effectively managed symptoms, only 28% reported increased energy levels. Changes to daily routine and diet were both reported by 22% of patients, however only 3% of patients reported an inability to adhere to their treatment consistently. Summary/Conclusion: In conclusion, patients prefer therapies with less frequent dosing, and, in concordance with previously published UK results, oral tablets and treatments without food restrictions. Despite treatment efficacy, improvement in energy levels is not guaranteed and many patients' lives are impacted by fatigue. Furthermore, some patients must accommodate their treatment with changes to daily routine and diet. These findings further highlight the importance of shared decision-making between clinicians and patients to ensure the prescribed TPO-RA has the best impact on patients' quality of life.